Request Provider Application

Electronic Billing Enrollment

DMBA will enroll a group or individual provider under the TPN assigned to them by UHIN for electronic transactions. Enrolling the group
or individual provider under the TPN ensures all electronic transactions through UHIN are received by DMBA.

If DMBA does not have a TPN on file, the group or individual provider wanting to submit electronic transactions, must go through
submission testing to pass HIPAA edits.

DMBA’s TPN is HT000006-001

Contact Information

If you have any questions about EDI enrollment, please contact DMBA at edienrollment@dmba.com
or by calling our Provider Maintenance Team at 1-800-777-3622 press Options 1, 3, and then 4.

If you would like to contact UHIN, you may visit their website at www.uhin.org, or call the Help Desk at 801-466-7705.